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Product Detail

Group Mediclaim Insurance

A Group Health Insurance plan provides cover to all the members in a single policy.

There are several advantages over buying an individual policy, which are:

  • Lower Premium Cost
  • Customized policy
  • Cover for all members
  • Cashless claim across network hospitals
  • Provides incentives for having affiliation with the group
  • Cover from day one of member joining the group.


Salient features of GROUP MEDICLAIM POLICY

The policy covers reimbursement of Hospitalisation expenses for illness/disease or injury sustained.

1.1 Amount payable Expenses as would fall under different heads mentioned below, and as are reasonable and necessarily incurred thereof by or on behalf of such Insured Person, but not exceeding the Sum Insured in aggregate in any one period of Insurance stated in the schedule hereto.

A) Room Boarding Expenses as provided by the Hospital/Nursing Home.

B) Nursing Expenses.

C) Surgeon, Anaesthetist Medical Practitioner, Consultants. Specialists Fee.

D) Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of pacemaker, Artificial Limbs and cost of Organs and similar expenses.

Sum Insured for the purpose of this policy shall mean “Floater Sum Insured” i.e. the aggregate sum insured indicated against each insured family unit which shall be available to “all or any one “basis to the family member during the period of this insurance policy.

1.2 Expenses on Hospitalisation for minimum period of 24 hours are admissible.

Note: When treatment such as Dialysis, Chemotherapy, and Radiotherapy etc. is taken in the Hospital/Nursing Home and the Insured is discharged on the same day, the treatment will be considered to be taken under Hospitalisation Benefit section.

3.1 PRE-HOSPITALISATION Relevant medical expenses incurred during period up to 30 days prior to hospitalization/domiciliary hospitalization on disease/illness/injury sustained will be considered as part of claim mentioned under item 1.2 above.

3.2 POST-HOSPITALISATION Relevant medical expenses incurred during period unto 60 days after Hospitalisation on disease/illness/injury sustained will be considered as part of claim as mentioned under item 1.2 above.

3.3 Qualified Nurse means a person who holds a certificate of a recognized Nursing Council and who is employed on recommendations of the attending Medical Practitioner.

4.0 EXCLUSIONS: The Company shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by any Insured Person in connection with or in respect of:

4.1 Pre-existing disease clause

4.2 30-days waiting period

4.3 Specific disease for the first year of the operation of the policy

4.4 Cost of spectacles and contact lenses, hearing aids.

4.5 Dental treatment or surgery of any kind unless requiring hospitalization.

4.6 Convalescence, general debility, Run-down condition of test cure, contract??? And external disease or defects or anomalies, sterility, venereal disease intentional self-injury and use of intoxicating drugs/alcohol.

4.7 All expenses arising out of any condition directly or indirectly cause to or associated with Human T-Cell Lymphotropic Virus Type III (IITLB-III) or Lvmphodinopathy Associated Virus (LAV) or the Mutant Derivative or variations Deficiency Syndrome or any Syndrome or condition of a similar kind commonly referred to as AIDS.

4.8 Charges incurred at Hospital or Nursing Home primarily for diagnostic, x-ray or laboratory examinations not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any ailment, sickness or injury, for which confinement is required at a Hospital/Nursing Home.

4.9 Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending Physician.

4.9.1 Injury or Disease directly or indirectly caused by or contributed to by nuclear weapons/materials.

4.10 Naturopathy Treatment.


5.1 The Insured person shall obtain and furnish the company with all original bills, receipts and other documents upon which a claim is based and shall also give the company such additional information and assistance as the Company may require in dealing with the Claim.

5.2 Any medical practitioner authorized by the company shall be allowed to examine the Insured Person in case of any alleged injury or disease requiring Hospitalization when and so often as the same may reasonably be required on behalf of the Company.

5.3 The Company shall not be liable to make any payment under this policy in respect of any claim if such claim be in any manner fraudulent or support by any fraudulent means or device whether by the Insured Person or by any other person acting on his behalf.